Comparing Breast Cancer Screening Rates Among Different Groups

Mammography screening is important for all women, regardless of their race/ethnicity or their risk of breast cancer. Along with follow-up tests and treatment if diagnosed, mammography can reduce the chance of dying from breast cancer.

Some women are less likely than others to get mammography screening. There are many reasons for disparities in breast cancer screening in the U.S. Some are described here.

31 percent of those with no health insurance had a mammogram in the past 2 years

68 percent of those with health insurance had a mammogram in the past 2 years

Although a lack of health insurance is a main reason for breast cancer screening disparities in the U.S., other factors play a role. Even among women 40-64 with insurance, only 68 percent had a recent mammogram [91].

The Affordable Care Act requires all new health insurance plans (since September 2010) to cover mammography every 1-2 years (with no co-payment) for women ages 40 and older [14].

Figure 3.7

Screening rates in the past

In the past, African-American women were less likely than white women to get regular mammograms [104]. Lower screening rates in the past may be a possible reason for the difference in survival rates today.

Black women now have slightly higher rates of mammography use than other women [91].

In 2015 (most recent data available), among women 40 and older, 69 percent of black women had a mammogram in the past 2 years (see Figure 3.6) [91].

Access to follow-up care

Access to follow-up care after an abnormal mammogram may explain part of the survival gap between African-American and white women.

Some, but not all, findings have shown that Black/African-American women may have more delays in follow-up after an abnormal mammogram than white women [105-107].

Delays in follow-up may play a role in the lower survival rates among Black/African-American women [103,108-109].

Other factors

Even after accounting for differences in income, past screening rates and access to care, Black/African-American women are diagnosed with more advanced breast cancers and have worse survival than white American women [108-112].

Differences in reproductive factors and breast cancer biology between Black/African-American women and white women also appear to play a role in these disparities [101,112-117].

Age at diagnosis

Black women who develop breast cancer tend to be diagnosed at a younger age than white women [118].

The median age at diagnosis for black women is 59, compared to 63 for white women [118]. The median is the middle value of a group of numbers, so about half of black women are diagnosed before age 59 and about half are diagnosed after age 59. Among white women, about half are diagnosed before age 63 and about half are diagnosed after age 63.

Hispanic/Latina women

Overall, Hispanic women have somewhat lower rates of breast cancer screening compared to other women, including black and white women (see Figure 3.6) [91,135]. However, the gap between breast cancer screening in Hispanic women and breast cancer screening in black and white women has gotten smaller over time [135].

Some findings show Hispanic women may have a higher number of barriers to getting screening mammography than women of other ethnicities [96].

Breast cancer screening varies

Screening mammography use among Hispanic/Latina women varies by group. For example, Puerto Rican women are more likely to get screening mammography than non-Hispanic white women [135]. Puerto Rican women are also more likely to get screening mammography than Cuban-American and Mexican-American women [135].

In addition, compared to Hispanic women who have lived in the U.S. for a short period of time, those who have lived in the U.S. for a long period of time are more likely to be screened [135]. Hispanic women who have health insurance are also more likely to get screening mammography than those who don’t have health insurance [135].

The importance of mammography

However, breast cancer is still the most common cancer (and the leading cause of cancer death) among Hispanic/Latina women [135]. So, screening in these women is just as important as it is for African-American and white women.

Hispanic/Latina women tend to be diagnosed with more advanced breast cancers than white women [135]. This may be due to lower mammography rates as well as more delays in follow-up after an abnormal mammogram [135].

American Indian and Alaska Native women

Among women ages 40 and older, 63 percent of American Indian/Alaska Native women and 66 percent of white women had a mammogram in the past 2 years (see Figure 3.6) [91].

One reason for these differences in screening rates may be access to care. American Indian and Alaska Native women tend to live in areas that require traveling a long distance to get health care, including mammography [121].

Breast cancer is the most common cancer among American Indian/Alaska Native women [1].

American Indian/Alaska Native women tend to have lower rates of breast cancer and breast cancer mortality than white/non-Hispanic white or black/non-Hispanic black women [103,120]. However, these rates vary according to where women live.

American Indian and Alaska Native who live in Alaska have the highest rates of breast cancer (similar to non-Hispanic white women) and those who live in the Southwest have the lowest rates [122].

Asian-American, Native Hawaiian and Pacific Islander women

Non-Hispanic Asian women in the U.S. have somewhat lower rates of breast cancer screening than other women [91]. Compared to white women, Asian women in the U.S. also have more delays in follow-up care after an abnormal mammogram [123].

However, breast cancer is the second leading cause of cancer death in Asian-American, Native Hawaiian and Pacific Islander women (lung cancer is the major cause of cancer death) [102]. So, screening in these women is just as important as it is for African-American and white women.

Gay, lesbian and bisexual women

Some findings show the rates of screening mammography among lesbians, bisexual women and heterosexual women are similar [124].

Some data even show screening mammography rates are higher among gay and lesbian women compared to straight women [91]. In 2015 (most recent data available) [91]:

78 percent of gay and lesbian women had a mammogram in the past 2 years

64 percent of straight women had a mammogram in the past 2 years

However, other findings show lesbians and bisexual women may not get regular mammograms [95]. This may be due to [125]:

Lack of health insurance

Perceived low risk of breast cancer

Past discrimination or insensitivity from health care providers

Low level of trust of providers

One step you can take is to find a provider who is sensitive to your needs. Networking with other women may be useful in finding such a provider.

Provider visits offer the chance to get health care, including breast cancer screening, on a regular basis.

Physical disabilities and breast cancer screening

Women with physical disabilities tend to get mammograms less often than women without such limitations [126-127]. One reason is lack of access to mammography centers that meet their needs [128-130].

Many mammography centers (especially mobile ones) simply aren't designed for women who have trouble getting around. Having a good experience increases the chances women with disabilities will return for routine mammograms [131].

If you have concerns about access, call the mammography centers in your area until you find one that meets your needs. Partnering with your health care provider in your search can make things go more smoothly.

Getting involved

Let your voice be heard by the larger community. If access to health care for the disabled isn't as good as it could be in your area, let your local medical centers, health insurance providers and elected officials know.

About 27 million women in the U.S. have a physical disability [132], making a powerful group to lobby for change.

Developed a free, online Breast Health Accessibility Resource Portal with materials to help Komen grantees around the globe improve their ability to care for women with disabilities.

AAHD was awarded a 2-year grant to continue their work to address barriers for women with disabilities in Washington, D.C. through our National Capital Region Community Grants Program. Primarily, this program supported women with disabilities living in Wards 2, 5, 7, and 8 in the District of Columbia. The project – Breast Cancer Awareness for Women with Disabilities - aimed to reduce breast cancer disparities for women with disabilities by targeting the community and health care providers in local mammography screening facilities. AAHD disseminated breast health educational materials, one-on-one education about breast health and conducted accessibility assessments at screening facilities to determine the structural barriers that prevent women with disabilities from receiving their mammogram.

Removing barriers to screening

Many barriers may make it hard for some women to get breast cancer screening and follow-up on abnormal mammograms.

Increasing access, awareness and sensitivity may help remove some barriers (especially for poor and uninsured women). This includes [91,133-134]:

Improving access to mammography and primary care

Removing financial barriers

Removing language barriers

Community education (such as health campaigns that address negative beliefs and feelings about mammography)

Ensuring health care providers working with women from different communities and cultures are sensitive to their needs. (When a provider doesn't recommend a mammogram, some women don't feel they need one.).

A goal of the Affordable Care Act was to reduce barriers to health care. It requires insurance plans to cover mammography costs (with no co-payment).

Since the time the Affordable Care Act became law, the gaps in screening mammography disparities between women with high and low income levels and between women with high and low education levels have declined [100].

Ensuring health care providers are sensitive to the needs of women from different communities and cultures is important. (When a provider doesn't recommend a mammogram, some women don't feel they need one.).

If you are 40 years or older (and not at higher than average risk of breast cancer) and your provider does not bring up mammography, ask him or her to talk with you about breast cancer screening and when and how often you should get a mammogram.

If your mammogram shows something abnormal, you will need follow-up tests to check whether or not the finding is breast cancer. It’s important to get follow-up without delay. If breast cancer is found, it’s best to be diagnosed and treated at the earliest possible stage. A patient navigator at your medical center may help you coordinate your follow-up tests.